Provider Demographics
NPI:1770691917
Name:WHITLER, SHERRY (ARNP)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:WHITLER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7129
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-7129
Mailing Address - Country:US
Mailing Address - Phone:270-442-0103
Mailing Address - Fax:270-442-0109
Practice Address - Street 1:1532 LONE OAK RD
Practice Address - Street 2:SUITE 415
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-7913
Practice Address - Country:US
Practice Address - Phone:270-442-0103
Practice Address - Fax:270-442-0109
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3721P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1068009Medicare ID - Type Unspecified
P94590Medicare UPIN